Hives, bumps, blotches and toe discoloration ― as doctors learn more about the coronavirus, reports are beginning to emerge that COVID-19-positive patients sometimes experience different kinds of rashes on their bodies. It turns out that “COVID toes” are indeed a thing, but they’re not the only skin symptom you may experience if you’re carrying the virus, and rashes may appear even after your infection has cleared.
James Bradley, a board-certified plastic surgeon at Northwell Health, has been working directly with hospitalized COVID-positive patients. He has seen a wide range of skin symptoms firsthand, usually in one area of the body.
“We have seen almost a hive-like rash on the trunk, and I did see one 6-year-old who had it around the belly button and back areas,” he said. “It’s pinkish, raised and itchy. I’ve seen other patients that it’s more like an eruption of small red bumps, which we’ve seen mostly in patients who are admitted with more serious infections going on. It’s hard for us to know if this is a viral manifestation or an immune response.”
Harold Lancer, a board-certified dermatologist, said there are a variety of potential skin issues to look out for.
“Skin findings in patients with COVID-19 can be extraordinarily diverse,” he told HuffPost. “Hive-like rashes, itchy or not, are the most common. Blotchy, red, migrating spots have also been noted along with areas that look like inflamed eczema, seborrheic dermatitis or perioral dermatitis.”
Doctors think COVID toes — when there are red blotches on or even a hypothermia-like appearance of the toes — may be a result of the virus causing inflammation of blood vessels. Fingers and toes have the tiniest vessels, and are therefore more at risk.
“A lot of the skin manifestations we see are representative of what’s going on internally with the organs, and fingers and toes relate to thrombosis and the damage to the inside of blood vessels,” Bradley said. “When you get blueish and reddish toes, it’s either thrombosis or damage to the vessels.”
Of course, COVID-19 is not the first virus to cause a rash — think chickenpox, measles, and hand, foot and mouth disease. But unlike these viral illnesses, not every person who is infected with COVID-19 will develop a telltale sign on their skin.
“There are papers coming out of Italy and China suggesting 2% to 20% have skin symptoms,” said Jessica Cataldi, a board-certified infectious disease specialist at Children’s Hospital Colorado. “It’s not the primary symptom for most people; the majority of people with COVID won’t have a rash.”
Reports in early May stated that children were experiencing rashes too, part of a new issue facing medical professionals: children seemingly developing Kawasaki disease, which causes inflammation in the blood vessels and a rash, during or after a COVID infection.
“In the skin, inflammation of the blood vessels can appear as excessive pink-red coloration all the way down to a paler, blanched look,” Lancer said of the COVID-related symptoms doctors have seen in children lately. “Nonetheless, it is a blood vessel inflammation and perhaps nerve inflammation. It is unknown if children are more likely to experience skin rashes than adults.”
Although all of these observations require further research, doctors agree that a COVID-related rash could pop up on someone who isn’t having any other symptoms. Whether that means their body wasn’t very affected by the virus, or whether it means it has already passed through, depends on the individual.
“There was a paper out of Spain published with over 300 patients, and in patients with lesions on the fingers or toes, less than half of them actually tested positive for COVID, whereas some of the other rashes I mentioned, a lot of those were testing positive,” Cataldi said. “What we’re wondering is for the toe findings, is that something that happens after the body has helped clear the virus and your body is responding? Especially with COVID toes, those seem to happen in people who may not have many other symptoms at all.”
“We have seen patients with just a rash and malaise who test positive for COVID. It could be one of the symptoms when you don’t have others,” Bradley explained.
If you see a rash or skin change developing that is unusual for you, Cataldi said it’s worth calling your doctor. A medical professional can advise on the best over-the-counter treatment or determine if you should make time to get tested for the coronavirus.
“If it’s new, different or something you haven’t experienced before, you should absolutely call your doctor and ask what they think,” she said. “A lot of doctors are doing telehealth right now and should be able to take a look at it. Think back, are there any new medicines you’ve been taking, or any new lotions or things you’ve been putting on you skin lately? You can call your doctor and have them look at that rash, and the best way to figure out if it’s COVID is to get tested.”
Experts are still learning about the novel coronavirus. The information in this story is what was known or available as of press time, but it’s possible guidance around COVID-19 could change as scientists discover more about the virus. Please check the Centers for Disease Control and Prevention for the most updated recommendations.
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